Biodiversity and health : a knowledge synthesis and analysis of the complex connections between biodiversity and health highlighting the relevant EU policies projects and initiatives.
Date: 2023-12-04
Institutions: Joint Research Centre
Subjects: EU environmental policy, EU policy, EU strategy, biodiversity, ecosystem, environmental protection, public health, research report, sustainable development

ISSN  1831-9424 

JRC  TECHNICAL  REPORT 

Biodiversity and health 

A knowledge synthesis and analysis of the complex connections between 
biodiversity  and health highlighting  the relevant EU policies 
projects and initiatives. 

Prakash, S., Estreguil, C., Neuville, A., Chinchio, 
E., Baccaro, M. 

2023 

 EUR 31758 EN 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
  
 
 
This publication  is a Technical  report 
aims  to provide evidence-based scientific  support  to the European policymaking  process.  The contents of this publication  do not 
necessarily  reflect the position  or opinion of the European Commission.  Neither  the European Commission  nor any person  acting on 
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area or of its authorities,  or concerning the delimitation  of its  frontiers or boundaries. 

Contact information  
Name: Knowledge Centre for Biodiversity 
Address:  TP124, via E. Fermi 2749, I-21027 Ispra (VA), Italy 
Email:  EC-Biodiversity-KC@ec.europa.eu 

EU Science Hub 
https://joint-research-centre.ec.europa.eu 

JRC134740 

EUR 31758 EN 

PDF  

ISBN 978-92-68-09895-0  

ISSN 1831-9424  

doi:10.2760/174144 KJ-NA-31-758-EN-N 

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© European Union, 2023 

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How to cite this report:  Prakash,  S., Estreguil,  C., Neuville, A., Chinchio,  E. and Baccaro, M., Biodiversity and health,  Publications  Office of the 
European Union, Luxembourg,  2023, doi:10.2760/174144, JRC134740.  

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Contents   
Abstract.............................................................................................................................................................................................................................................................1 

Acknowledgements...........................................................................................................................................................................................................................2 

1  Introduction ........................................................................................................................................................................................................................................3 

1.1  State of knowledge on biodiversity and human health: a brief overview  ......................................3 

1.2  Complexity of relationships and research challenges ................................................................................................6 

1.2.1  Terminology and variables.............................................................................................................................................................6 

1.2.2  Methodological considerations .................................................................................................................................................6 

1.2.3  Diversity of perspectives and expertise .......................................................................................................................6 

2  EU action on biodiversity and health ..............................................................................................................................................................8 

2.1  EU policies relevant for biodiversity and health.................................................................................................................8 

2.1.1  Biodiversity and health in EU policy ..................................................................................................................................8 

2.1.1.1  Biodiversity and health in the evolution of the EU's overarching 
environmental policy framework ........................................................................................................................................................8 

2.1.1.2  Mainstreaming health in EU biodiversity policies ..............................................................................8 

2.1.2  Other EU policy areas relevant for biodiversity and health..............................................................9 

2.1.2.1  Pollution and waste: air, water and soil ..........................................................................................................9 

2.1.2.1.1  Overarching EU policy framework on pollution and waste.................................9 

2.1.2.1.2  Air quality ............................................................................................................................................................................ 10 

2.1.2.1.3  Water......................................................................................................................................................................................... 10 

2.1.2.1.4 

Soil ................................................................................................................................................................................................ 12 

2.1.2.1.5  Waste........................................................................................................................................................................................ 12 

2.1.2.2  Agriculture, food systems and nutrition...................................................................................................... 12 

2.1.2.3  Climate change and disaster risk reduction .......................................................................................... 13 

2.1.2.4  Disease prevention, medicines and wellbeing.................................................................................... 14 

2.1.2.4.1  Disease prevention................................................................................................................................................. 14 

2.1.2.4.2  Mental, physical and cultural wellbeing .................................................................................... 16 

2.1.2.4.3  Medicines ............................................................................................................................................................................. 16 

2.2  EU support for projects and initiatives relevant to biodiversity and health............................. 18 

2.2.1  EC Research & Innovation initiatives ........................................................................................................................... 18 

2.2.1.1  FP7 (2007-2013) programmes.............................................................................................................................. 18 

2.2.1.2  Horizon 2020 (2014-2020) programmes................................................................................................ 19 

2.2.1.3  Horizon Europe (2021-2027) ongoing calls/programmes................................................. 19 

2.2.2  CINEA support .............................................................................................................................................................................................. 20 

3  Conclusions ..................................................................................................................................................................................................................................... 21 

References ................................................................................................................................................................................................................................................ 23 

List of abbreviations and definitions ................................................................................................................................................................... 38 

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List of figures ....................................................................................................................................................................................................................................... 39 

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Abstract  

Biodiversity and health are inextricably connected, directly as well as indirectly. Nature and biodiversity 
directly enhance health and wellbeing by improving the quality of our air, water and soil, and providing 
indispensable medicines, food and nutrients. Anthropogenic drivers of biodiversity loss and ecosystem change 
such as pollution, agricultural intensification and climate change affect both biodiversity and health, an d are 
in turn aggravated by the loss of biodiversity and ecosystem services. The connections are complex and 
involve many feedback loops, calling for reinforced attention from many policy domains as part of a systemic 
approach. In this report we chart out these connections and the relevant policy domains, as well as the 
corresponding EU policies, projects and initiatives. The main aim is to improve awareness on the strong, 
complex and manifold connections between nature conservation and human health with a view to enhancing 
win-win solutions in policymaking. 

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Acknowledgements   

We would like to thank Marine Robuchon and Jorge Ventocilla working for the 
Knowledge Centre for Biodiversity for their inputs to an earlier draft of this report, as well as Maria Luisa 
Paracchini from the Joint Research Centre for her comments. 

Authors 

Sona Prakash (independent consultant, working for the EC Knowledge Centre for Biodiversity) 
Christine Estreguil (EC JRC Directorate D - Sustainable Resources) 
Aude Neuville (EC JRC Directorate D - Sustainable Resources - EC Knowledge Centre for Biodiversity) 
Eleonora Chinchio (EC JRC Directorate F - Health and Food)  
Marta Baccaro (EC JRC Directorate F - Health and Food) 

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1 

Introduction  

This study is part of a series initiated by the Knowledge Centre for Biodiversity (KCBD) to raise awarenes s o n 
the importance of embedding biodiversity concerns in all relevant policy domains. The series  des crib es th e 
efforts of the European Union in this direction, key to effecting transformative change and a green transition . 
The  content  targets  a  wide  audience,  prioritising  accessibility  for  the  layperson  as  well  as  interest for 
specialists, policymakers and researchers. All the reports in the series follow a common structure, which  was  
originally designed for the thematic pages of the website of the KCBD1, and determined collectively with other 
knowledge centres as part of the Knowledge for Policy (K4P) initiative of th e E uropean  Commiss ion. Th is  
report focuses on the direct as well as indirect connections between biodiversity and health, and describes the 
relevant EU policies, projects and initiatives. 

1.1  State of knowledge on biodiversity  and human health: a brief overview 

Increasingly, the contribution of biodiversity2 to human health3 and well-being is being rec ogn is ed in  peer- 
reviewed literature [1, 2, 3] and by international governments and organisations such as th e Co nvention  of 
Biological Diversity (CBD) and the World Health Organization (WHO) [4]. Biodiversity u nd erpins  eco system  
functioning, providing a wide range of goods and services that ensure our health and wellbeing. It im pro ves  
the  quality  of  the  air  we  breathe  and  the  water  we  drink, regulates temperature in cities, and provides 
medicines, food and nutrients that maintain our health. Biodiversity is indispensable for the planet's capacity 
to both regulate and adapt to environmental change 

 especially climate change and natural disasters.  

A growing amount of research has been published in the past two decades on the contribution of biodivers ity 
to human health, including topics like medicine, food and nutrition, analysing benefits and harms in term s o f 
physical and mental health and wellbeing, and within the context of climate change [1,  2,  3]. An  ex tens ive 
literature has also focused on the contribution of green spaces to physical and mental health [5, 6]. Guegan et 
al. [7], Loreau et al. [8], and Kopnina et al. [9] have developed societal and ecological perspectives  inc ludin g 
issues of public health, social-environmental equity and education. 

Based on a broad literature review, Sandifer et al. [10] identified a wide rang e o f m ental an d ph ysiog ic al 
benefits from contact with nature such as, among others, reduced anxiety and depression, improved cognitive 
function, reduced cardiovascular and circulatory diseases, reduced sympathetic/increased  paras ympa thetic 
nerve activity, faster healing after illness, surgery or trauma, and positive influence on diabetes. Green spaces 
are reported to be beneficial for child brain (cognitive and behavioural) development [11]. Mental health4 and  
psychological wellbeing5 benefits relate notably to stress reduction and relaxation, e.g. throug h th e c alming  
effect of greenery and birdsongs and the quietness and fresh air induced by a walk in th e wo ods  [12]. Th e 
recognition of benefits of contact with nature is slowly contributing to the integration of hu man  health and  
wellbeing objectives into the management of some biodiverse areas of high conservation value [13],  like in 
the case of urban nature parks supporting migratory birds while playing a role in improving  air q uality an d 
moderating air temperature [14] or in initiatives such as the Biophilic Cities network6.  

Lindley et al. [15] looked in particular at physical health and highlighted the following links with biodiversity: i) 
 ecosystem, natural environments with diverse biota enrich th e h um an 
at the level of the human body
microbiome through exposure to beneficial symbiotic microbes, and the d ecline in  
c on tact with  
nature contributes to the development of dysbiosis, which may result in a negative cycle of ill-heath, including 
problems  associated  with  the  integumentary  (skin/hair), digestive and urinary/renal systems as well as 
disorders in the respiratory and cardiovascular systems [16, 17]; ii) specific physiological positive ou tcomes  
from contact with nature are shown for the circulatory/cardiovascular, endocrine and immu ne s ystem s and  
protection from chronic inflammatory disorders, however with mixed evidence [18]; iii) at the broader level o f 
landscape biodiversity, a correlation has been shown between biodiversity (including vegetation diversity and  

1 https://knowledge4policy.ec.europa.eu/biodiversity_en  
2 Biological diversity: variability among living organisms from all sources including, inter alia, terrestrial,  marine and other aquatic 
ecosystems  and the ecological complexes  of which they are part: this includes diversity within species, between species and of ecosystems 
(CBD, 1992) 
3 Human health: a state of complete  physical, mental and social well being and not merely  the absence  of disease or infirmity (WHO 1948) 
4 Mental health: a state of wellbeing in which an individual realizes their own abilities, can cope  with the normal stresses of life, can work 
productively and is able to make  a contribution to their community (World Health Organisation, 2018 at https://www.who.int/news-
room/fact-sheets/detail/mental-health-strengthening-our-response   

5 Psychological wellbeing: a combination of positive affective states such as happiness (the hedonic perspective)  and functioning with 

optimal effectiveness  in individual and social life (the eudaimonic perspective)  (Winefield  et al., 2012) 

6 http://biophiliccities.org/   

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species  richness)  and  positive  respiratory health [19]; iv) many ecosystem processes contribute to food 
nutritional quality and diversity, which are important for ensuring good physical health [20]. Biodiversity also  
affects  human  health  by  making  (e.g. agricultural) ecosystems more resilient (e.g. pest regulation) and 
possibly more productive for food (e.g. crop pollination, fish stocks ). Van d en Bo sc h and Sang  [21] h ave 
underlined the direct and indirect pathways linking physiological health and exposu re to  nature. E m phasis 
could be on ecosystem regulatory functions (e.g. modification of environmental stressors) or on provisionin g 
functions (such as the use of ecosystems by people for food, freshwater, fuel an d m edicines ) [15]. Direc t 
pathways include for example the health benefits from the consumption of nutritiou s foo d while in direct 
pathways include the benefits from increased physical activity in nature.  

Among others, Müller et al. [22] and Morand and Lajaunie [23] have clarified the academic debates o n wh at 
role biodiversity and its loss play in vector-borne diseases (VBDs)7. Epidemiological d ynamics o f VBDs are 
complex interactions of the vector species, the pathogen and the host; it is now well es tablish ed th a t the 
transmission of infectious or parasitic agents depends on abiotic factors, climatic factors (temperatu re and 
rainfall) and the degree of biodiversity (e.g. landscape heterogeneity, species richness, reservoir host diversity) 
as well as its loss or alteration. However, important knowledge gaps remain on e.g. the context-dependence of 
VBD processes, seasonal and spatial distributional changes of vector species under climate change,  and th e 
correlation of species richness and composition in explaining the dilution effect (i.e. decreased  d is eas e ris k 
with increasing diversity within a given ecological community - for example the effect was repo rted  in th e 
case of Lyme disease) [24].  

When  identifying  factors  impacting  human health, researchers also point out the inter-relationships of 
biodiversity (and its loss) and climate (and its changes). They stress the urgent need for action in the lig ht o f 
recent climate change projections, on-going biodiversity losses and public health demands [2,  3]. Th e 2016 
Global Environment Outlook (GEO-6) assessment for the pan-European region [25] identified biodiversity as a  
key environmental determinant of human health. But many gains in human development over the last century 
have come at the cost of biodiversity and the state of the natural environm ent,  bo th within and  ou tside 
Europe, and the later effects of this now cause health problems. Environmental factors cause an  es timated 
1.4 million deaths per year in the region [26]. These factors include inter alia air pollution, poor water q uality 
and climate change, which have interlinkages with biodiversity loss and ecosystem degradation, as have other 
factors influencing the spread of non-communicable as well as infectious diseases [see Section  2.1.2]. Th e 
VBD issue is of increasing concern since on average, 77,000 people living in Europe fall sick from VBDs every 
year8, and numbers are predicted to increase as more vector species emerge (e.g. the Asian tiger m os qu ito , 
Aedes albopictus) or re-emerge (e.g. the yellow fever mosquito, Aedes aegypti). Globally, every year there are 
more than 700,000 deaths from zoonotic vector-borne diseases such as malaria, Lyme and dengue.  

The  key  regional  drivers  [4]  of  biodiversity  loss  are  linked  to  increased  land-use  change:  agricultural 
intensification  including  livestock,  urbanisation  and  habitat  fragmentation.  Other  pressures  include 
unsustainable direct exploitation of biological resources and invasive species. These d rivers an d pres s ures  
affect human health by causing biodiversity loss, the degradation of ecosystem services and deterioratio n o f 
food quality, as well as via other impacts such as increasing pollution and waste, and  climate ch an ge. Th e 
latter impacts further undermine ecosystem services and biodiversity, and are in tu rn a gg rava ted b y their 
loss.  The  same  drivers  contribute  globally to the emergence and spread of infectious diseases and are 
considered to lie at the root of many recent pandemics [27, 28]. A variety of mechanisms are at play here: for 
instance, habitat loss and fragmentation force wild animals out of their natural habitat and into closer contact 
with humans, augmenting the likelihood of human exposure to zoonotic infections and the possible spread of 
these diseases. While proximity to host species is not sufficient per se to increase zoonotic disease risk , a s  it 
needs  to  be  considered  along  with  other factors affecting transmission related to the host species, the 
pathogen  itself  and  the  local  environment  and  species  communities  (e.g.,  pathogen  prevalence  and 
transmission route/s, human behaviour, type and frequency of c ontacts  between  animals  an d h umans , 
landscape structure, etc.) [29, 30], anthropogenic changes in land use are undoubtly ex pan ding h azard ou s 
interfaces  between  people,  livestock  and  wildlife  reservoirs  of  zoonotic  diseases  [31,  32].  Morand and 
Lajaunie [23] brought evidence on the link between global deforestation  an d o utb reaks o f z o onotic  an d 
vector-borne  diseases;  they  also  found  that  reforestation, mostly in temperate countries, and oil palm 
plantations in tropical countries, may also contribute to epidemics of infectious diseases . M üller et al. [22] 
made recommendations to address VBD control from an interdisciplinary and trans-sectoral approach,  n ot 

7 vector-borne  diseases (VBDs): illnesses caused by parasites, viruses or bacteria  that are  transmitted by a vector, such as mosquitoes, ticks, 

sandflies,  triatomine bugs, tsetse flies, fleas,  black flies, aquatic  snails and lice (WHO 2017a).  

8 http://www.euro.who.int/en/media-centre/sections/press-releases/  2014/77-000-europeans-fall-sick-every -year-with-vector-borne-diseas es 

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just in the health sector. Morand and Lajaunie [2] called for an international governance framework involving  
scientists, public health officers and policymakers to ensure the preservation of forests and th e ec os ystem 
services they provide, including the regulation of diseases. Biodiversity should be considered  as well as th e 
health risks posed by lack or mismanagement of forest ecosystems. 

For Morand and Lajaunie [23], among other sources, the biodiversity and health n exu s o ffers  the u n iq ue 
opportunity to demonstrate how ecological, environmental, medical and social sciences can contribute to  th e 
improvement of human health and wellbeing through the conservation of biodivers ity an d th e s ervices it 
brings  to  societies. Cross-disciplinary approaches and collaboration are necessary for addressing these 
complex inter-linkages and for ensuring coherence. Towards this goal, two approaches [33] ad opted  at th e 
European and global levels can be quoted: 

  The  planetary  health  approach  [34],  which  seeks  to  promote  human health by protecting the natural 
systems on which it depends. This approach investigates the effects of environ mental ch ang e o n h uman 
health and wellbeing, as well as the political, economic and social systems governing those effects. 

  The  One  Health  approach  [35],  which focuses on addressing health concerns in the animal human
environment interface. It seeks to bring multiple sectors to communicate and work together to wards  better 
health outcomes by designing and implementing joint programmes, policies, legislation and research.  

36], aimed at 
improving protection against health emergencies   including pandemics such as COVID-19   and facilitatin g 
healthy lives and wellbeing through health-promoting local environments. The programme s eeks to  en su re 
that environmental risks affecting both humans and animals are tackled in an inter-sectoral manner,  as s et 
down in the 2017 Ostrava declaration [26] at the Sixth Ministerial Conference on Enviro nmen t an d Health , 
part of the European Environment and Health Process (EHP) [37]. In a recent joint statement [38], the relevant 
EU agencies expressed their commitment to support the One Health agenda in Europe. 

Figure 1. Examples of issues that can be addressed through a One Health approach  

Source: Cross-agency knowledge for One Health action, Joint Statement by European Union agencies, by 
ECDC, ECHA, EEA, EFSA and EMA, November 2023. ©EEA 

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1.2  Complexity of relationships  and research challenges 

Although there is growing appreciation and an emerging body of evidence on the impo rtan t links b etween 
nature and biodiversity and human health, the research is heterogeneous in the definitions an d appro ach es 
used, and there is a need to improve our understanding of the underlying  mec han is ms [10,  20]. Cu rren t 
research  challenges  related  to  the  biodiversity-health  nexus  lie  on  theoretical  and  methodological 
considerations (terminology and metrics, diversity of concepts and methods, interdependence of pro ces ses ), 
the diversity of perspectives and expertises represented, as well as the understand in g o f th e n exu s in  th e 
context of future scenarios of climatic and societal changes.  

1.2.1  Terminology and variables 

Biodiversity 

In the body of research on biodiversity and health, many interpretations exist of the term biodiversity and th e 
ways in which it is measured when assessing its contribution to human health [39]. This brings inconsistencies 
in the results. Broadly defined terms like nature, natural environments and green spaces are u sed :  n ature  
referring to living things and associated landscapes in a wide variety of settings;   green  s pac es  th at m ay 
support  different  levels  of  biodiversity  and  may  have  different  management  objectives  and  public 
accessibility conditions, the (i.e. an urban park could be managed primarily for people while pro tec ted areas 
with high biodiversity value may only offer limited access to people). Marselle et al. [3] have recommended  a 
systematic approach based on biodiversity variables organised into three levels: (i) ecosystem /habitat (e.g . 
landscape heterogeneity, structural diversity), (ii) species communities (e.g. species richness, perceived species 
richness, abundance of a specific taxonomic group), and (iii) single species level. 

Health 

Numerous parameters would be necessary to determine in a robust manner the health s tatus  of any on e 
person.  They  should  relate  to  individual  characteristics  (e.g.  hereditary  genetics),  external  factors  (e.g. 
abundance, type and quality of the natural environment) and life experiences, both physical an d s ocial  [10, 
15]. To fully determine physical health, physiological variables to be measured should be associated with 11 
interlinked body systems: reproductive, integumentary (skin/hair), skeletal, muscular, n ervou s (brain/b rain 
activity),  circulatory/cardiovascular 
(blood/transport  of  nutrients),  endocrine  (glands/hormones), 
lymphatic/immune, digestive (food), respiratory (breathing) and urinary/renal (waste). In turn, each parameter 
could be systematically assessed in order to establish underlying mechanisms for the influence of nature. On  
the psychological side, mental wellbeing variables should more systematically include attention res toration,  
recovery from stress, emotion/mood, and quality of life/life satisfaction, while  m ental h ea
is  a noth er 
variable to be recorded individually for e.g cognitive function.  

1.2.2  Methodological considerations 

Inconsistencies in terminology and incomplete sets of variables affect th e q uality o f s ys tematic s earch  
process  and  data  mining  for  knowledge  synthesis.  Difficulties  are  further  encountered when selecting 
inclusion/exclusion criteria of terms qualifying biodiversity and health. This has an impact on the ro bu stnes s 
of the evidence built on the biodiversity-health relationships. The diversity of methodologies applied  to  link 
biodiversity and health may lead to inconsistencies and an incohesive body of evidenc e [40]. An alys es are 
complex  and  should  take  into  account  direct  and  indirect  pathways,  relevant  controls  and  the 
interdependencies between psychological and physiological processes [15]. 

The inter-relationships between biodiversity and climate present additional challenges for building and testing 
hypotheses and exploring future scenarios. 
human  health  and  wellbeing,  influencing  other  factors  that  affect  human  health  through  the natural 
environment, and the full extent of health impacts from biodiversity losses thus remains unclear [15].  

1.2.3  Diversity of perspectives and expertise 

Knowledge syntheses on the biodiversity and health nexus draw from a variety of disciplines ran ging  fro m 
ecology, geography and animal health to environmental psychology, public health and medical s c ien ce a nd  
encompassing nature conservation and land/urban planning. Such research is multi-layered  and in heren tly 
multi-disciplinary; links are multiple, interconnected, multi-scale and interdependent.  

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Complexities are compounded due to differing perspectives on issues, for example with s ome res earc hers  
using health as a primary starting point and other researchers starting from the perspective of environmental 
or ecological processes. The different perspectives are important for developing fuller understanding, but still 
make  the  challenges  of integrating all the research more demanding, especially at the science-practice 
interface [15]. Different disciplines have unique perspectives to offer, and further efforts in interd is ciplina ry 
collaboration are needed to contribute to a cohesive body of evidence, to inform strategies  o r po lic ies  th at 
aim for win-win scenarios for both biodiversity conservation and physical and mental health and wellbeing.  

Action is needed due to climate projections, biodiversity losses and health demands. New research ag endas 
demand ambitious, multi-disciplinary and cross-sector approaches. A holistic approach in policy and practice is 
as important as it is in scientific research [15]. Practical questions are essential to address, s uch  as d one in  
Eklipse multi-stakeholders consultations9 on biodiversity in an urban context or biodiversity and pan demics : 
What  habitat  types  and elements of biodiversity in green and blue spaces in urban areas help promote 
physical health? How can these types and elements be considered within the plann in g pro ces s  and  within 
health  and  social  care  systems?  What  are  on-the-ground  actions  (failures  and  successes)  aiming  at 
understanding the emergence of zoonotic and infectious diseases and their prevention?  W hat are relevan t 
indicators (including social) for biodiversity and climate change to help prevent futu re pand emics?  How to  
translate information to stakeholders and the young generation? 

9 http://www.eklipse.eu/ 

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2  EU action on biodiversity  and health 

Under EU action we consider EU policies and EU-funded projects and initiatives relevant to biod ivers ity an d 
health. As biodiversity is essential for human and planetary health, any EU action to reverse biodiversity lo s s 
benefits our health, directly or indirectly. In addition, many drivers of biodiversity loss, such as pollu tion and  
climate change, also severely affect human health. Actions that mitigate their impacts are thus beneficial to  
both biodiversity and health, as are many actions taken in other domains such as food systems and d isease 
prevention. Section 2.1.2 on EU policies in these domains (pollution, food systems, climate ch ang e, d isease 
prevention, etc.) also explains how these domains are closely linked to biodiversity and health. 

2.1  EU policies relevant for biodiversity  and health 

In  Section  2.1.1  we  summarise  connections with health issues in the EU's biodiversity and overarching 
environmental policies, whilst Section 2.1.2 deals with other policy domains that are closely lin ked  to  bo th 
biodiversity and health. 

2.1.1  Biodiversity and health in EU policy 

Section 2.1.1.1 describes how biodiversity and health, and the linkages between them, have been integrated in 
the EU's overarching environmental policy. Section 2.1.1.2 summarise the incorporation of health issues in EU 
biodiversity and nature-based policies. 

2.1.1.1  Biodiversity and health in the  evolution of the EU's overarching environmental policy 

framework 

-annual environment action pro g rammes  
that define a common long-term vision towards ensuring coordinated action of the EU and its Member States. 
The EU's 6th Environment Action Programme (EAP) (2002-2012) [41] identified fou r main prio rity areas:  
climate change; nature and biodiversity; environment and health; natural res ourc es and  was te. Th e final 
assessment (2011) [42] of the 6th EAP reported that targets were met only for climate change. Key challenges 
on nature and biodiversity remained unaddressed, and a coherent approach on environment and h ealth  was  
lacking. Targets on natural resources and waste were only partially met. The 7th EAP (2013-2020) [43] h a d 

resource-efficient, green, and competitive low-carbon economy; and to safeguard the Union's  c itiz ens fro m 
environment-related pressures and risks to health and wellbeing. The Commission's evaluation of the 7th EAP 
(2019) [44] reported that   while there has been progress across the board   major challeng es rem ain:  we 
face a global ecological crisis as we cross-planetary boundaries, this crisis affects human health, and th e E U 
is not on track to meet its biodiversity targets. The Communication (2019) [45] on the European Green  Deal 
(EGD) prioritised swiftly achieving climate and environmental targets while protecting peo ple' s  health and  
wellbeing from environmental risks and impacts, and ensuring a just and inclusive transition. 

The proposal for an 8th EAP (October 2020) [46] stated that decisive further action is required for addressin g 
biodiversity  loss  and ecosystem services degradation, climate change, unsustainable use of resources, 
pollution and associated risks to human health and wellbeing, nature,  ec os ys tems , and  the ec o nomy. It 
acknowledged that the current growth model has exacerbated environmental pressures that are expec ted to  
increase further, with direct and indirect effects on human health. It called for an accelerated transition  to a  
regenerative  growth  model,  envisioning  a  regenerative economy by 2050 where a healthy environment 
underpins our health and wellbeing, where biodiversity thrives and natural capital is protected, res tored  a nd 
valued, thereby also enhancing resilience to climate change and other environmental risks. The General Unio n 
Environment Action Programme to 2030 (8th EAP, adopted in 2022) [47] emphasised that economic ac tivity 
should develop in a way that protects, restores and improves the state o f the en viron ment,  inclu ding  by 
halting and reversing biodiversity loss, prevents environmental degradation, and protects health and wellbeing 
from  negative  environmental  risks  and  impacts,  preventing  and  minimising  pollution. It aimed to fully 
integrate the One Health approach across all levels of policymaking. Pursuing zero pollution is o ne o f its s ix 
priority objectives. 

2.1.1.2  Mainstreaming health in EU biodiversity policies 

The  evaluation  (2022)  [48]  of  the  EU  Biodiversity  Strategy  to 2020 concluded that its targets were not 
achieved. Despite increased efforts, the EU fell short of achieving its headlin e target to  h alt and  revers e 

8 

 
 
biodiversity loss in the EU by 2020, and did not fully achieve any of the other targets. However, progress wa s 
made  in  certain  areas  despite  continuing  pressures.  Health  was not directly addressed. In 2020 the EU 
adopted the Biodiversity Strategy for 2030 (EU-BDS 2030) [49], underscoring the importanc e of n ature fo r 
our mental and physical wellbeing, as well as for our society's ability to c ope with  glo bal c h ang e, h ealth 
threats and disasters. EU-BDS 2030 addresses multiple drivers of biodiversity loss, most of which also impact 
human health. The older Habitats [50] and Birds Directives [51] also include considerations of pu b lic  health. 
The 2013 EU Strategy on Green Infrastructure (GI) [52] recognises that GI delivers health-related  ben efits  
such as better air and water quality, and that healthy ecosystems also reduce the s pread  of vecto r -b orne 
diseases.  It  aims  to  ensure  the  protection  and enhancement of GI via strategic spatial planning. It was 
supplemented and reviewed [53] in 2019, specifically with a view to mainstreaming in other EU policies  su ch 
as nature protection, agriculture, climate, water and scientific research. In addition, nature -b as ed s olu tio ns  
[54], which support several major EU policies [55], including the European Green Deal, EU-BDS 2030 and  th e 
climate adaptation strategy, are known for their multiple health benefits [56]. 

2.1.2  Other EU policy areas relevant for biodiversity and health 

EU  policies  in  several other areas are relevant to the connection between biodiversity and health. These 
include policy domains such as pollution, agriculture and climate change, which impact both biodiversity and 
human health   and are in turn impacted by the loss of biodiversity and ecosystem services. Another relevant 
domain is that of medicine, health and wellbeing, which relies heavily on biodiversity. The following s ection s 
2.1.2.1 to 2.1.2.4 are devoted to these policy domains. Each section firstly explains how the selected  do main 
relates to biodiversity and health, and secondly describes the relevant EU policies.  

2.1.2.1  Pollution and waste: air, water and soil 

The declining quality of air, water and soil severely harms human health as well as biodiversity. On the oth er 
hand, ecosystems and biodiversity help maintain and improve air, water and soil quality, thereby en hancing  
human health. Pollution causes heart and pulmonary disease, diabetes, mental and neurological co nditions  
and other ailments. In 2015 pollution caused [57] an estimated 9 million premature deaths worldwide   three 
times more than AIDS, tuberculosis, and malaria combined, and 15 times more than war and ag gres sion . It 
causes 1 in 8 deaths annually in the EU [58]. Pollution   in particular pesticides,  end ocrin e dis rupto rs and  
loading of nitrogen and phosphorus [59] from agriculture and transport   is also one of the main  drivers  of 
biodiversity loss and the ongoing extinction of species. 

2.1.2.1.1  Overarching EU policy framework on pollution and waste 

The EU's Zero Pollution Action Plan or ZPAP (2021) [60] is based on the following vision for 2050: 

Air,  water  and  soil  pollution  is  reduced  to  levels  no  longer  considered  harmful  to  health  and  natural 
ecosystems and that respect the boundaries our planet can cope with, thus creating a toxic-free environment. 

Its targets for 2030 include a reduction by 55% of health impacts (premature deaths) of air pollution; by 30% 
of the share of population chronically disturbed by transport noise; by 25% of the EU ecosystem s wh ere air 
pollution threatens biodiversity; by 50% of nutrient losses, use and risk of chemical pes ticides , u se o f th e 
more hazardous ones, and the sale of antimicrobials for farmed animals  and in  a quacu lture;  by 50%  of 
plastic litter at sea and by 30% microplastic release into the environment; b y 50% o f res id ual m un ic ipal 
waste and significantly total waste generation. The ZPAP hierarchy emphasises the precautionary princ iple,  
preventive action, rectification of environmental damage at source, and the 'polluter pays' principle. It includes 
a 'flagship' to reduce the EU's external pollution footprint. 

The Sustainable Use of Pesticides Directive (SUD) (2009) [61] aimed at reducing risks to human h ealth  and 
the environment via alternative approaches such as Integrated Pest Management, an approach to preven ting  
and/or suppressing pests aiming to keep the use of plant production products to levels that are justified b oth  
economically  and  ecologically,  encouraging  the  use  of  non-chemical alternatives for sustainable crop 
protection. The Commission proposal (2022) [62] transforms the existing Directive into a Reg ulatio n o n  the 
Sustainable Use of Plant Protection Products, namely the Sustainable Use Regulatio n (SUR),  which  will b e 
directly binding for the EU Member States (MS). It includes strengthened pro vis io ns  as  well as targets  to  
reduce  by  50%  at  EU  level the use and risk of chemical pesticides and the use of the more hazardous 
pesticides by 2030, in line with the EU-BDS 2030 [49] and the EU-Farm to Fork (F2F) [63] s trateg ies,  new 
measures to promote an environmentally friendly system of pest control, an d a b an o f pes ticides  in any  
ecologically  sensitive  area to be preserved for threatened pollinators. In January 2023, the Commission 

9 

 
 
published a staff working document10 on the drivers of food security, showing that biodiversity loss is among  
the main drivers, and that pesticide use reduction is expected to exert positive effects  on  s oil health a nd  
biodiversity. At the European Parliament, the Commission proposal was referred  to  th e Committee o n th e 
Environment, Public Health and Food Safety (ENVI). In November 2023, the Parliament rejected the pro po sa l 
at the first reading11. The Council still has to decide on its position to d etermin e wheth er th e pro pos al is  
definitively rejected or will return to Parliament for a second reading. 

Chemical manufacturing is the EU's fourth largest industry. The EU Chemicals Strategy for Su stainab ility 
(2020) [64], which is part of the zero-pollution ambition, recognises  the n eg ative impacts  of h azardo us 
chemicals on human health and the environment, as well as the need for the existing EU chemicals po licy  to  
evolve  and  respond  more  effectively  to challenges posed by hazardous chemicals. Key points to tackle 
included, among others, the need to address risks derived from exposure to mixture of chemicals, which m ay 
lead to cumulative and synergistic effects, and to cover data gaps still existing for many substan ces , as th e 
information currently required in registration dossiers does not allow for a comprehensive hazard assessment, 
including  for  carcinogenicity,  neurotoxicity,  immunotoxicity  and  endocrine  disru ption.  To  this  end,  the 
Registration, Evaluation, Authorisation and Restriction of Chemicals or REACH (2007) Regulation [65] is b ein g 
revised to align it with EC ambition on protecting health and the environment, following a public consultatio n 
[66] launched by the Commission in 2022. Different policy options for possible amen dmen ts o f RE ACH to 
modify requirements for registration of low tonnage substances (1-10t/year) and to increase n ew appro ach 
methodologies (NAMs)-based information on critical hazards at all tonnage levels were proposed by th e JRC 
in 2021. The Commission formulated options that are currently under discussion, taking into c on sideration 
results from comprehensive impact assessments [67]. The proposal in preparation for the REACH revis io n is  
expected to introduce more stringent provisions on information requirements, hazard classification and  risk 
management  of  chemicals  of  concern,  including  substances  causing  carcinogenicity,  neurotoxicity, 
immunotoxicity and endocrine disruption, as well as persistent, mobile and bio-accumulative substances. 

2.1.2.1.2 

Air quality 

Air pollution harms both human health and ecosystems. It is now the single largest risk to h uman  h ealth in  
Europe, annually causing hundreds of thousands of premature human deaths (over ten times more than ro ad 
traffic accidents) [68, 69] and is a leading cause of respiratory and card iovas cular d is eas e. M ore th an 6 
million new cases of cardiovascular disease [70] are diagnosed in Europe every year. Fine particulate matter,  
carbon monoxide, ozone, nitrogen dioxide and sulphur dioxide are the main pollutants of concern  for h uma n 
health. Air pollution also impacts both vegetation and wildlife, threatening almo st two -th ird s o f Eu rope' s 
ecosystems12 [69]. Excess nitrogen deposition [59] is a major cause of species loss, ecosystem  dys fu nction  
and eutrophication. Conversely, ecosystems benefit air quality [4] in many ways: for instance via rem oval o f 
air pollution and meteorological regulation. 

The Clean Air Policy Package for Europe was adopted in December 2013 based on an extensive review o f E U 
air policy to date. Its Clean Air Programme [71] aimed to achieve full compliance with ex is tin g air q uality 
standards  across  the  EU  as  soon  as  possible,  and set objectives for 2020 and 2030. As set out in the 
subsequent (2018) communication [72], the EU's wide-ranging policy efforts towards clean air for all res t o n 
three main pillars aimed at preventing or reducing harmful effects on human health and the environment a s 
a  whole.  The  first  pillar  comprises  the  ambient  air  quality  standards set out in the Ambient Air Quality 
Directive [73] for ground-level ozone, particulate matter, nitrogen oxides, d angero us  heavy meta ls a nd  a 
number of other pollutants. Member States (MS) are required to adopt air quality plans  to  adh ere to  th ese 
standards. The second pillar consists of national emission reduction  targ ets  establish ed in  th e Natio nal 
Emissions Ceiling Directive [74] for the most important trans-boundary air pollutants: sulphur oxides, nitrogen  
oxides, ammonia, volatile organic compounds and fine particulate matter. The third pillar comprises emissions 
standards for key sources of pollution, from vehicle and ship emissions to energy and industry. 

2.1.2.1.3  Water 

Water is a precondition for life and health, and plays a fundamental role in climate regulatio n. E cos ystems  
facilitate the water cycle by regulating nutrient cycling and soil erosion [75], and m anaging  pollu tion [76]. 

10 https://commission.europa.eu/publications/analysis-main-drivers-food-security_en 

11 : No majority in Parliament for  legislation to curb use of  pesticides | News | European  Parliament (europa.eu) 
12 https://www.eea.europa.eu/publications/air-quality-in-europe-2022/impacts-of-air-pollution-on-ecosystems,  in EEA, 2022 [39] 

10 

 
 
                                              
 
 
Species loss hinders ecosystem services such as pollutant filtration and nutrient uptake [77]. Many protected  
areas were established to protect human water supply. But human activity is now th reaten in g fres hwater 
ecosystems [78], resulting in water quality decline. The main anthropogenic drivers are increased fresh water 
consumption for agriculture, mining, energy generation, industry and households. Nutrient discharge [79] in to 
water  bodies  leads  to  eutrophication,  widely  recognised  as  a  major  threat  to  both  human health and 
ecosystems. Excess nitrogen (in agricultural runoff, etc.) and phosphorus (in detergents , etc .) are th e main 
culprits, with multiple impacts including cyanotoxin outbreaks [80] in  h um ans  an d anima ls, an d o xygen  
depletion of ecosystems. Apart from direct health impacts (such as water-related illness), degradation caused 
by human activity affects access to sanitation and water resources, and the capacity for fo od pro d uction . 
Maintaining or restoring ecosystems is a cost-effective and sustainable way [81] to impro ve water q u ality, 
delivering substantial benefits for biodiversity and health. 

EU water legislation shares an overarching objective of protecting human health and the environ ment fro m 
the combined effects of toxic and/or persistent pollutants, in light of increasing pressure on  Eu rope' s  water 
resources  [82].  The  Water  Framework  Directive  (WFD)  [83]  adopted  in  2000 is the most comprehensive 
instrument  of  EU  water  legislation. It was supplemented in 2006 by the Groundwater Directive [84] and 
amended  in  2008  by  the  Directive  on  environmental  quality  standards  in  water  policy  [85].  The  water 
blueprint (2013) [86] facilitated its implementation by identifying remaining obstacles and ways to overcome 
them. The WFD applies an integrated river basin approach to managing fresh, coastal and transitional waters 
while respecting the integrity of whole ecosystems that are key to safeguarding water res ou rces . Its  main 
objective was to achieve 'good status' (ecological and chemical) for all EU waters by 2015, in tandem with a  
number of other directives on specific aspects. But later reports [87, 88] show that the WFD's objectives were 
not achieved: in 2019 only 40% and 38% of EU surface water bodies had  g ood  eco logical and c hem ic al 
status respectively, despite improvements for individual substances. With respect to groundwater,  74% and  
89% of groundwater area had good chemical and quantitative status respectively.  

The Urban Wastewater Treatment Directive (1991) [89] aimed at protecting the environmen t from ad vers e 
effects  of  wastewater  discharge.  Its forthcoming review will consider permanent monitorin g of health-
relevant factors in wastewater with a view to improve preparedness for new epidemic threats. Th e Nitrates  
Directive (1991; amended in 2003 and 2008) [90] aimed at mitigating water pollution c aused  b y n itrates 
from agricultural sources in order to protect human health and aquatic ecosystems, and to safeguard o ther 
legitimate  uses  of  water.  The  Priority  Substances  Directive  (2013)  [91]  aimed  at  preventive action and 
rectification  at  the  source  of  the  adverse  effects  of  surface  water  pollution:  impacts  on  the  aquatic 
environment  such  as  acute  and  chronic  toxicity  in  aquatic  organisms,  accumulation  of  pollutants  in 
ecosystems and loss of habitats and biodiversity, as well as the threat to human health. Since January 2023,  
the recast Drinking Water Directive (2020) [92] provides higher human health protection via m ore s tring ent 
quality standards. Furthermore, the Marine Strategy Framework Directive (2008) [ 93] n o ted  the m ou nting 
pressure on the EU's natural marine resources and called for an ecosystem-based  appro ach  to m an agin g 
these resources to phase out pollution (substances and human-induced underwater noise) and reduce risks to  
marine biodiversity and ecosystems, human health and legitimate uses of th e s e a. W ith  fresh water and  
marine biodiversity being a source of food, the bioaccumulation of chemical pollutants in aquatic o rga nisms  
can lead to human dietary exposure to such substances. The Commission is reviewing th e Marine Strategy 
Framework Directive since the related report (2020)13that assessed the first cycle highlighted that biodiversity 
loss was not halted in European seas. 

EU water legislation includes lists of pollutants and quality standards, and req u irem ents  fo r th eir reg ular 
review.  The  2019  fitness  check  [88]  confirmed  the  need  to  update  these  lists  and  to  improve  the 
effectiveness,  efficiency  and  coherence of water legislation. This led in October 2022 to a Commission 
proposal to amend the WFD and its daughter directives [94]. The proposal's general objectives are to increase 
the protection of EU citizens and natural ecosystems in line with the EU-BDS 2030, ZPAP and the EGD, and to  
increase the effectiveness and reduce the administrative burden of water leg is lation,  en ablin g th e E U to  
respond more quickly to emerging risks. 

13 COM(2020) 259 final. Report from  the Commission to the European  Parliament and the Council on the implementation of the Marine 

Strategy Framework Directive  (Directive  2008/56/EC) {SWD(2020) 60 final  at https://eur-lex.europa.eu/legal-
content/EN/TXT/HTML/?uri=CELEX%3A52020DC0259 

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2.1.2.1.4 

Soil 

Soil is an essential ecosystem containing more than 25% [95] of all living organisms on the planet. It provides 
food, biomass and fibres, and regulates water, carbon and nutrient cycles, making life possible. Soil pollution 
is rampant in the EU: about 2.8 million sites are potentially contaminated [96], of which 390,000 are expected 
to  require  remediation.  About  65,500  sites  had  been remediated by 2018.  Pesticide residues in soil are 
widespread in the European agricultural soils (74.5% according to [97]) and this raises concern regarding their 
known negative impact on soil biodiversity [98]. Consequently, the loss on biodiversity leads to a decrease in  
organic matter and alteration of nutrient cycling which in turn affect the soil productivity.   

The new EU soil strategy for 2030 [95] replaces the former EU Thematic Strategy for Soil Protection  (2006) 
[99],  aiming  to achieve healthy soils by 2050, with concrete objectives for 2030. Its key actions include 
sustainable soil management, boosting the circular economy by enhancing land reuse an d reach ing n o n et 
land take by 2050, restoring degraded soils and remediating contaminated sites, preventing desertificatio n, 
increasing research (data and monitoring), and mitigating and adapting to climate change. A new Soil Health  
Law has been proposed [100] by the Commission in 2023 to ensure a level playing field and a h igh  level o f 
environmental and health protection. Public feedbacks14 on this proposal have been collected  till No vem ber 
2023 in order to then proceed towards the adoption of a Directive on this to pic. Un der th e n ovel Horiz on 
Europe initiative EU Missions [101], the mission A Soil Deal for Europe [102] aims to lead th e trans itio n to  
healthy soils by 2030. The BDS 2030 and F2F strategies [Section 2.1.2.2] also cover m any aspec ts o f so il 
health, such as nutrient pollution and erosion control. 

2.1.2.1.5  Waste 

Total annual EU waste generation [103] amounts to 2.2 billion tonnes, or 4.8 tonnes per capita a year. W as te 
electrical and electronic equipment (WEEE) continues to be one of the EU's fastest growin g was te s treams. 
Discarded devices contain hazardous materials that can cause major environmental and health  pro blems  if 
not managed properly. 

The Waste Framework Directive (2008) [104] aimed at protecting the enviro nment an d h uman h ealth  by 
preventing or reducing waste generation and its adverse impacts, and improving resource use efficiency. Th e 
RoHS Directive regulating 'Restriction of Hazardous Substances' in electrical and electronic equ ipm ent [105] 
and the WEEE Directives regulating their waste [106] (2011-12) specifically ta rget W EEE . Bu t d espite E U 
efforts, the amount of waste generated has not decreased. The EU's First Circular Economy Action Plan [ 107] 
(2015)  was  completed  by  2019. Though recycling of municipal waste increased in that period, recycled 
materials still meet less than 12% [108] of EU demand for materials. 

The  new  Circular  Economy  Action  Plan  (2020)  [109]  proposes  a revision of EU legislation on batteries, 
packaging, end-of-life vehicles, and hazardous substances in electronic equipment with a view to preven ting 
waste, increasing recycled content, promoting safer and cleaner waste streams, and en su ring h igh -q uality 
recycling. In addition, the EC will put forward waste reduction targets for specific streams as part of stron ger 
measures on waste prevention and a review of the Waste Framework Directive. However, les s th an  40% o f 
electronic  waste  is  recycled  in  the  EU.  Its  informal  recycling  in  developing  countries exposes people to 
numerous harmful substances [110], such as lead and mercury, with a major impact on children. Th e E C will 
support initiatives via the Basel Convention to better monitor international trade for these waste-streams and 
improve their management, as well as explore a global initiative to end informal recycling of used lead  acid 
batteries. The European Commission is currently evaluating the WEEE Directive to addres s th e n eed for its  
revision and an on-line public consultation15 was open until the end of September 2023. 

2.1.2.2  Agriculture, food systems and nutrition   

Agricultural intensification is one of the main causes [111, 112] of b iodivers ity lo ss  in E uro pe, an d also 
directly impacts human health. On the other hand, biodiversity in and around agricultural sys tems is  o f key 
importance for food security and health [4]. It is the source of the components of production (crops, livestock, 
farmed fish), and the genetic diversity within these [113] that ensures co ntinuin g impro vements  in foo d 
production, allows adaptation to current needs and ensures adaptability to future ones. A diversity of species  
and varieties, as well as wild sources, underpins dietary diversity [114] and good nutrition. Biodiversity is also 

14 https://ec.europa.eu/info/law/better-regulation/have-your-say/initiatives/13350-Soil-health-protecting-sustainably-managing-and -restoring-

EU-soils_en 

15 https://environment.ec.europa.eu/topics/waste-and-recycling/waste-electrical-and-el ectronic-equipment-weee_en 

12 

 
 
                                              
 
essential for agricultural production systems, underpinning ecosystem s ervices  s uch  as  po llination , pes t 
control,  nutrient  cycling,  erosion  control  and  water  supply.  While  agric ulture and food systems rely on 
biodiversity in many ways, biodiversity also relies on agriculture [112]: it is estimated that 50% of all spec ies 
in the EU rely upon agricultural habitats. Diversity loss in agro-ecosystems has increased the vulnerability and 
reduced the sustainability of production systems, as well as having negative impacts on human health. It h as 
also weakened regulating and supporting ecosystem services, thus making these systems more dependent on 
additional chemical inputs and creating negative feedback loops. The use of chem ic al in puts , particu larly 
pesticides, has had severe consequences for wildlife, human health and agricultural biodiversity.  

The EU Farm to Fork Strategy (F2F) [63] proposes a transition to a more sustainable food system. It aim s to  
comprehensively address the challenges involved while recognising the inextricable links b etween h ealthy 
people,  healthy  societies  and  a  healthy  planet.  It  recognises  the  urgent  need  to reduce dependence on 
pesticides and antimicrobials, reduce excess fertilisation, increase organic farming, improve animal welfare,  
and reverse biodiversity loss. Both BDS 2030 and F2F go beyond the Pesticides Directive in including spec ific 
targets for halving the use and risk of chemical pesticides in agriculture and  th e us e o f m ore h az ard ous  
pesticides by 2030, as well as enhanced provisions on integrated pest managemen t and s afe altern ative 
ways to protect harvests from pests and diseases. F2F and BDS 2030 also have specific targets for red u cing 
nutrient pollution (halving nutrient loss and reducing fertiliser use) and expanding organic farming to 25% o f 
EU agricultural area, as well as an integrated nutrient management plan to a d dres s n utrient po llu tion a t 
source. The EU has a comprehensive legal framework [115] based on official controls in MS to ensure a h igh  
level of health protection and trust in the areas of food and feed safety; animal an d plant h ealth; an ima l 
welfare; organic farming, and other factors, throughout the food and feed c hain, fro m farm to  fork, and  
appropriate monitoring. Regarding animal welfare, a Eurobarometer16 was ru n b ack in 2016 an d a pu blic 
consultation run in 2021 by the EC has highlighted the need to update the current law and align it to  rec ent 
scientific evidence and societal expectations (e.g. on-farm rearing, transport, slaughter and  lab elling)  also 
recalling the ambition of the EU as a global leader on animal welfare. Intensive animal agriculture is booming 
in  many  countries outside the EU (e.g Brazil, Argentina, China, India) that are main exporters of animal 
products to the EU and where only vague and/or non-binding farmed animal welfare standards apply, causing 
animal welfare problems, but also being environmentally unsustainable and a threat to public health. 

The  Common  Agricultural  Policy  (CAP)  for  2023-2027  [116]  seeks  to  provide  more targeted support to 
enhance the contribution of agriculture to EU environmental and climate goals and allow greater flexibility for 
Member States in adapting the measures to local conditions. It is intended as a key to ol for ach ieving  th e 
ambitions of the F2F and EU-BDS 2030. Four of the new CAP's nine specific o bjectives  rela te direc tly or 
indirectly to 'biodiversity and agriculture'. In line with the recommendations from previo us  evalu ation s,  a 
number  of  changes  have  been  introduced  that  are  expected  to  achieve  a  greener  CAP  with  regard  to 
biodiversity objectives. These include notably: a more strategic approach to improve targeting, as both pillars 
are combined under a single CAP Strategic Plan (SP) for each MS, which must explicitly take into accoun t key 
EU  environmental  legislation;  improved  monitoring  and  tracking  of  the  impact  of  CAP  expenditure  on 
biodiversity; higher ambition to be demonstrated in each CAP SP on environment and climate action compared 
to the previous programming period; stronger support and incentives for farmers , as at leas t 25% o f th e 
budget for direct payments is allocated to eco-schemes, and under pillar 2 (rural development),  MS h ave to  
spend at least 35% of allotted funds on measures to support climate, biodiversity, environment an d animal 
welfare;  and  stronger  conditionality  rules  linked  to  CAP  payments  such  as a new obligation to protect 
wetlands and peatlands and a minimum share of at least 4% of arable lan d d evoted to  n on -pro duc tive 
features (the share can be reduced to 3% if farmers commit to reach 7% through eco-schemes).   

2.1.2.3  Climate change and disaster risk reduction 

Climate change impacts health and biodiversity directly as well as indirectly [117], and the c on nection s are 
complex. Heat waves and other climate-related disasters have direct impacts on h uman h ealth  [ 118] and  
ecosystems, while several indirect impacts on human health are mediated by climate impacts on ecosystems 
and biodiversity [119]. These range from less resilient food systems to the spread of water -related , fo od-
related, and vector-borne disease. There are many feedback loops: for instance, climate chang e c an red u ce 
water and air quality, damaging human health as well as ecosystems and biodiversity, which in tu rn affects  
water and air quality. Climate change accelerates biodiversity loss, which in turn red u ces th e res ilienc e of 
ecosystems and agriculture against climate change, as well as their capacity to adapt to it. Clim ate c h ang e 

16 https://data.europa.eu/data/datasets/s2096_84_4_442_eng?locale=en 

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also  affects  agricultural  production,  food  and  water  security,  the  nutritional  content  of food, and the 
distribution and abundance of fish stocks, all of which impact human health. It is also likely to amplify the 
impact of other drivers [117] such as land use change, pollution, and invasive species on both human h ea lth 
and biodiversity. As interplay, air pollution is one of the main cause of climate change, and industrial farming , 
livestock production as well as deforestation accelerate both climate c h ang e a nd b iodivers ity lo ss , with 
significant health impacts. 

Ecosystem degradation and the collapse of ecosystem services can precipitate disasters  inc lu ding  dis eas e 
epidemics, floods, storms and wildfires, with adverse consequences for human health and  for ec osys tems. 
Climate-related disasters are on the rise [120], and ecosystem degradation increas es th e vu lnerability o f 
human  populations  to  such  events.  The  creation  of  disaster-resilient  societies  will  be essential, and is 
dependent on resilient ecosystems and their sustainable and secure delivery of goods and services: n ot o nly 
those associated with disaster resilience, but also those that normally support communities. Long-term health 
is an important indicator of community resilience against disasters. 

The 2021 EU climate adaptation strategy [121] noted that climate-related health threats are in creasing  in 
Europe. These include death and injury from heat, floods or wildfires; threats to food and water s afety and 
security, and the emergence and spread of infectious diseases and allergens fro m geo graphical s hifts  in 
vectors  and  pathogens.  EU  public  health  systems  will  be  affected.  The  European  Climate  and  Health 
Observatory [122] was launched in 2021 to address knowledge gaps on climate change impacts  on  hu man  
health.  Recognising  that  human  health  is  inextricably  linked  to  animal  and  environmental  health,  the 
Commission has adopted the 'One Health' approach in analysing and preventing c limate c h ang e impacts , 
including via the One Health European Joint Programme [123]. The EC pro po s al for th e 8th  E nvironmen t 
Action Programme [46], as well as the 8th EAP [47], called for strengthening the links between  climate and 
health policies, and specifically mentioned the need to address the impacts and risks o f c limate c hange to  
human health and wellbeing. The EC proposal on a European Health Union [124] add ress es s eriou s c ros s-
border threats including those from environmental and climatic conditions.  

The  EU  climate  adaptation  strategy  also emphasises nature-based solutions [125] for building climate 
resilience and sustaining healthy water, oceans and soils in a cost-effective way: by protecting and res to ring 
wetlands,  peatlands,  coastal  and  marine  ecosystems;  developing  urban  green  spaces;  promoting  and 
sustainably managing forests and farmland. Nature-based solutions are particularly effec tive fo r bo ostin g 
climate resilience against water impacts.  Climate change is aggravating situations of either too much o r no t 
enough water in Europe, as well as threats to water quality: it increases the risk of contaminated fresh water 
due to low river flows, high water temperatures, flooding and forest loss. In  o rder to  en su re s us tainable 
freshwater supply and quality, the Commission is prioritising the Common Implementation  Strateg y of th e 
Water Framework Directive [83] and the Floods Directive (2007) [126]. The latter aims  at red ucin g flood -
related impacts on human health, the environment, cultural heritage and economic activity. 

2.1.2.4  Disease prevention, medicines and wellbeing  

Biodiversity  plays  an  indispensable  role  in  sustaining  human  health  by  containing  and  preventing the 
occurrence and spread of diseases, enhancing mental and physical wellbeing, and providing  res ourc es  th at 
enable innovation in modern medicine as well as the maintenance of traditional systems of medicine. 

2.1.2.4.1  Disease prevention 

Recent research is increasingly focusing on the significant role played by the loss of biodiversity and  natura l 
habitats in the rise of several non-communicable as well as infectious diseases, including global pandemics. 

Environmental microbial diversity and non-communicable diseases (NCDs) 

NCDs are on the rise globally, and Europe is the most affected [25]. NCDs cause o ver 80%  of th e d is eas e 
burden in the EU [127, 128] and 90% of all deaths [129]. There is mounting evidence that many (autoimmune 
diseases,  type  1  diabetes,  multiple  sclerosis,  allergies,  eczema,  asthma,  etc.) can be linked to depleted 
microbial diversity in the human microbiome [130]. Recent research also po ints  to  links b etween altered  
microbial diversity and mental disorders [131, 132]. The diversity of bacteria, virus es,  fu ng i,  archaea and  
protozoa contained in microbes, and microbial interaction within the complex human microbio me, in flu ence 
both the physiology of disease and susceptibility to it. Microbial interchange with en vironmen tal m icrob ial 
ecosystems  diversifies  the  human  microbiota  [133]  and  helps  regulate  the immune system as well as 
enhances  the  adaptability  of  human  microbiota  (in  digesting  new  foods,  for  instance).  Failing 

14 

 
 
immunoregulatory mechanisms [134], partly attributable to reduced contact with the natural environment and 
biodiversity, can also lead to poor control of background inflammation.  

Furthermore, many mechanisms that regulate our immune systems were co-created via human co-evolutio n 
with other organisms [130]. Some of these mechanisms have negative health effects and are elimina ted b y 
modern medicine, especially in high-income settings like Europe. This em phasises  th e impo rtanc e o f th e 
immunoregulatory role of the microbial environment especially in these settings [134].  

population. Moreover, people suffering from NCDs can be more affected by other diseases, as COVID-19 has 
shown. From 2018 to 2022 the Steering Group on Health Promotion, Disease Prevention and Management of 
Non-Communicable Diseases [135] provided expertise to the Commission on developing an d implem enting  
activities for health promotion, and NCD prevention and management, promoting coordination between MS in 
addressing these challenges. From 2022 onwards its work is being continued under the broader framework of 
the expert group on public health [136], which expands these activities to include o ther n ew pu blic h ealth  
challenges, including communicable diseases. The EU Green Infrastructure Strategy [52] promotes increa s ed 
exposure to nature and its attendant benefits for NCD mitigation. 

Infectious diseases 

Infectious diseases cause over a billion human infections and millions of deaths per year globally. Th ey also 
affect plants and animals, undermining food and water supply, with additional impacts  o n h uman h ealth . 
Two-thirds [4] of known human infectious diseases are shared with animals, and th e m ajority o f rec en tly 
emerging diseases are associated with wildlife [137]. Anthropogenic practices [138] such as land-use change 
and antimicrobial use damage ecosystems, leading to increased infectious disease trans miss io n ris ks  an d 
impact. For instance, loss of natural habitat forces wild animals into human-inhabited areas, facilitating  th e 
spread  of  zoonotic diseases [28]; these constitute 60% of emerging infectious diseases, of which 72%  
originate in wildlife [137]. Whilst high-biodiversity areas may have more pathogens, biodiversity also protects  
against pathogen exposure via regulating functions such as host species competition. Biodiversity loss is seen 
as  a  key  driver  of  emerging  infectious diseases, while biodiversity conservation can provide additional 
habitats  for  species,  reducing  the  potential  contact  between  wildlife,  livestock  and  humans,  and thus 
modulating  the  risk  and  emergence  of  zoonotic  disease  in  humans   [139, 140]. There are however still 
important  knowledge  gaps  and  academic  debates  regarding  the  relationship  between biodiversity and 
infectious disease risk, due to the variety and complexity of the mechanisms involved in disease transmission 
and emergence [2, 22, 141]. The dynamics of infectious diseases can be indeed affected by genetic divers ity 
within host populations, species diversity within host communities, and diversity among commun ities . Field  
studies of plants, aquatic invertebrates, amphibians, birds, and mammals demonstrate that the phenomeno n 
of the so-called  dilution effect  (decreased disease risk with increasin g s pec ies  d ivers ity with in  a given 
ecological community) does occur in many natural systems. However, in a multi-ho st d isease s ystem , th e 
reduction of a species can potentially cause either the increase or the decrea se o f th e tra n smiss ion o f a 
certain disease, depending on the role of those species as hosts, and on many other factors [24]. The ability to 
predict when and where the dilution effect occurs remains poor, in particular on whether species ric hn ess  or 
species composition (both being metrics of biodiversity) drives disease risk, or maybe the correlation of both.  

At the same time, pathogen dynamics are also changing: global travel, climate change and antimicrobial u s e 
are rapidly affecting pathogen movement, host ranges, and persistence and virulence. Beyond direct infectio n 
risks, such changes also impact food security and medicine. Infectious diseases not only threath en h umans , 
but also wild and domesticated species, as pathogen spill-over can occur both ways. An area o f in creasing  
concern in this sense is reprensented by wildlife trafficking. A key issue in terms of animal welfare,  wild life 
trafficking can also increase the risk of introduction and/or the spread of infectious diseases, either z oon otic 
or relevant to wild or farmed animal populations [142, 143]. Building on the previous EU Action Plan ag ains t 
wildlife trafficking (2016-2020), the Commission adopted in November 2022 a revised Ac tio n Plan , which  
foresees four main priorities: the prevention of wildlife trafficking addressing its root cause, the strengthening 
of  the  legal and policy framework, the enforcing of regulations and policies to fight wildlife trafficking 
effectively, and the strengthening of the global partnership of source, consumer and transit countries  [144]. 
Trafficked species, if voluntarily or accidentally released in the environment, may also become invas ive. Th e 
introduction of invasive alien species [145] via trade and travel has been a phenomenon constantly increasing 
during the last decades [146], with impacts on both biodiversity conservation and human/an imal h ealth , as 
these species can alter population and infectious disease dynamics in the areas where they are in trod uced  
through several mechanisms [147,148,149].  

15 

 
 
 
The agenda for a European Health Union (2020) [124] was presented in the midst of widespread oc curren ce 
of COVID-19. Of the people affected globally, 25% were living in Europe at the time. The ag enda d escrib es 
long-term trends such as pressures on biodiversity, climate change and antimicrobial resista nc e as  fac tors 
aggravating the spread of infectious diseases worldwide and in Europe. Un ders coring  th e cru cial ro le o f 
improved preparedness against increasing outbreaks, it cites climate ch an ge m itig ation and  adaptation , 
biodiversity preservation and restoration, improved diets and lifestyles, and pollution reduction and  remo val 
from the environment as important elements. The amended proposal for a E uro pean  Centre fo r Disease 
Prevention  and  Control  [150] recommends a One-Health approach that recognises the interconnections 
between human and animal health and the environment. The activities of the expert group on pu blic h ealth  
[136] cover infectious diseases as well as NCDs. 

2.1.2.4.2  Mental, physical and cultural wellbeing  

It is well established that biodiversity is central to many cultures and traditions, and that mental and physical 
health benefit from exposure to nature and biodiversity [151]. Given that 74% of the EU's population is urban  
(55% globally) [152], there is a rising trend for people to be separated from nature and its h ealth  b enefits . 
The resulting alienation or "extinction of experience" [153] also exacerbates a cycle of disaffection  toward s 
nature. 

Studies of populations [4] in developed countries show that access to natural green spaces and b iod ivers ity 
has significant health benefits [154], stemming notably from increased physical activity, exposure to microbial 
diversity [155, 156] as well as psychosocial factors. These benefits include [132] lower incidence and ris k of 
mental illness (such as depression, anxiety and stress), cardiovascular diseases and NCDs, improved im mune 
function, and reduced overall mortality. Reduced recuperation times and impro ved rec overy o utc omes  in 
hospital  patients  have  also  been  reported.  Exposure  to  nature  is  especially  important  for  childhood 
development and health [157-161]. Children who grow up close to nature are more likely to conserve nature 
themselves as adults [162-163], while those in developed countries increasingly suffer from "natu re-defic it 
disorder" due to lack of outdoor activity [164].  

In terms of cultural wellbeing [4], species, habitats, ecosystems and lands capes in spire fo rms o f mus ic, 
language,  art,  literature  and  dance.  They  are  essential  to food production systems, culinary traditions, 
traditional medicine, rituals, worldviews and social systems.  

Green infrastructure (GI), as laid out in the EU Strategy on Green Infrastructure [52, 53] is key fo r pro vid in g 
increased exposure to nature, especially in nature-deprived urban environments. The European Parliamen t's  
pilot project on BiodiverCities [165] aims to engage citizens in vision -b uilding  toward s en hancin g u rban 
biodiversity, and to assess how urban GI can provide local and regional benefits. Further GI d evelo pmen t is 
being informed by reports on the impact of nature-based solutions [166] and the health and social benefits of 
nature and biodiversity [167] in the EU. These indicate multiple benefits for physical, psychological and social 
wellbeing at the individual and community level: ranging from social cohesion to improved mental health and 
reduced cardiovascular and respiratory diseases. 

2.1.2.4.3  Medicines 

Modern pharmaceuticals  

Most diseases that afflicted or killed people a century ago are today curable or preventable thanks to modern 
medicines, many of which are derived from biodiversity and natural products [4]: one of the most direct lin ks  
between biodiversity and medicine. Antibiotics that greatly improved human health in the 20th century derive 
from microorganisms: the penicillins, as well as nine of thirteen other major classes of antibiotics .  Nature-
derived antimicrobials (antibacterials, antivirals, antiparasitics, antifungals) constituted more than 75% [ 168] 
of those approved by the Food and Drug Administration of the United States ( USFDA) between  1981 a nd 
2010. Despite substantial advances in synthetic drug design, biodiversity co ntinues  to  be c ru cial for th e 
development of new drugs and treatments, as well as for providing new insights into human health. M o st o f 
the medicinal potential of nature has yet to be tapped [1]: plants have been the single greates t so urce,  b ut 
the majority have not yet been studied [169] for medicinal potential. Microbial and marine organisms, studied  
only since recently, hold vast potential [1]. Finally, of even greater importance than the medicinal potential of 
individual species is the insight that biodiversity and ecology provide in to h ow infection s are tack led b y 
natural means. Yet many of these crucial organisms, species and habitats are increasingly endangered  with 
extinction [1] by human action.  

16 

 
 
On  the  other  hand,  the  release  of  pharmaceuticals  both  from  human  and  veterinarian  use  into  the 
environment  [170]  presents  dangers  for  biodiversity  as  well  as  human  health.  A  range  of  active 
pharmaceutical ingredients or APIs (active pharmaceutical ingredients such as hormones, antimicrobials  and 
anti-depressants) have been detected in rivers and streams [171] across the world. Designed to interact with  
a specific target (receptor, enzyme or biological process) in humans and animals, they also affect org an is ms 
in the natural environment. APIs can be released via aquaculture and pasture animals and via manufacturing  
processes, sewage systems, surface water or soils [171, 172-174]. Limiting antimicrobial use would pro vide 
biodiversity and health co-benefits; excessive use alters the human microbiome and cultivates antimicro bial 
resistance (AMR) [175]: highly resistant bacterial strains in plants, animals and humans, increasing the risk o f 
disease and death. Endocrine-disrupting chemicals [176] and non-steroidal anti-inflammatory drugs have also 
had adverse effects on ecosystems, wildlife and human health. 

Directive 2008/105/EC [85] (amended by the Priority Substances Directive 2013/39/EU [91]) on environmental 
quality standards in water policy requires the European Commission to develop a strategic approach to water 
pollution from pharmaceutical substances, and to address the environmental impact.  

Antimicrobial resistance (AMR) causes 35,000 deaths every year in the EU, and leads to high costs, inc lud in g 
175].  In  November  2020,  the  new  Commission Implementing 
Decision (EU) 2020/1729 [177] on the monitoring of AMR in zoonotic and commensal bacteria was published , 
as part of the 2017 EU One Health Action Plan against Antimicrobial Resista nce [178]. In  Ju n e 2023 th e 
Council adopted the Recommendation on stepping up EU actions to combat antimicrobial resistance in a On e 
Health approach [179]. The EU4Health regulation [180] establishing the new EU4Health programme (2021 -
27) includes the specific objective of "supporting the prudent and efficient u se o f med ic inal pro d ucts , in  
particular antimicrobials, and actions to support the development of medicinal products that are less harmful 
for the environment, as well as the environmentally friendly production and disposal of medicinal pro duc ts."  
The  Farm  to  Fork  Strategy  aims  to halve overall EU sales of antimicrobials for farmed animals and in 
aquaculture by 2030. 

Traditional medicine 

Millions  of  people  rely  on  traditional  medicine  [181]  based  on  biological  resources,  well-functioning 
ecosystems  and  the  context-specific  knowledge  of  local health practitioners. Plants used in traditional 
medicine  are  crucial  for  local  healthcare,  but  also  for  global  innovations  in  healthcare  [182]  and  the 
associated international trade. They enter global commodity chains based on information gathered from their 
use in traditional medical pharmacopeia. Many of these plant and animal res o urc es are o n th e verg e o f 
extinction [183], mainly due to overharvesting, habitat alteration and climate chang e. Th is also  threatens  
livelihoods [4] of practitioners and collectors, who are often poor. Traditional medical knowledge often inspires 
industrial R&D processes in bio-resource based sectors, necessitating mechanisms to secure attrib ution  an d 
sharing of rights and benefits with knowledge holders, as set out in the Nagoya Protocol from the Conventio n 
on Biological Diversity (CBD) [184] on access to genetic resources and equitable sharing of b enefits  arising 
from their utilization, to which the EU is a signatory.  

The simplified registration procedure for traditional herbal medicinal products intro duc ed b y EU Directive 
2004/24/EC [185] clarifies uncertainties in the status of these products and facilitates their free m ovemen t 
through harmonised rules. It was intended for herbal medicinal products with a long tradition of medicinal use 
which do not fulfil "well established use" requirements for marketing authorisation, i.e. pu b lish ed s cien tific 
literature on recognised efficacy and safety. The Committee for Herbal Medicinal Products (HMPC) [186],  s et 
up in 2004 at the European Medicines Agency (EMA), was tasked with establishing monographs for traditional 
herbal medicinal products. A new HMPC work plan [187] was adopted in January 2023. 

17 

 
 
 
 
Figure 2. Biodiversity and health infographic as displayed by the EC Knowledge Centre for Biodiversity 

Source: Emilie Weynants 

2.2  EU support  for projects  and initiatives relevant to biodiversity  and health 

2.2.1  EC Research & Innovation initiatives  

A  variety  of  EC  initiatives  under  the  FP7  (2007-13)17  and  Horizon 2020 (2014-20)18 programmes have 
supported research and innovation relating to biodiversity and health. Over this time period, a list of 150 E U-
funded relevant projects was extracted through a projects mining exercise based on selected terms qualifying 
biodiversity and health with a focus on animal health, animal welfare and zoonoses. Results are available at 
the dedicated EU research project-policy link explorer page19. Queries based  o n o ther term s c ou ld b e ru n 
freely  at  the  EU  research  project-policy  link  explorer  page20  from  the  KCBD website. Regarding the new 
Horizon  Europe programme (2021-27)21, calls under the second phase (2023-24) are ongoing (HE work 
programme for 2023-2422) and a list of calls can be consulted for the HE work programme for 2021-2223. 

2.2.1.1  FP7 (2007-2013) programmes 

Specific Programme "Cooperation": Food, Agriculture and Biotechnolo gy (FP7 -KBBE) aimed  a t advanc ing 
knowledge in the sustainable management, production and use of biological resources (microbial, pla nt an d 

17 FP7: Seventh framework  programme  of the European  Community for research  and technological development  including demonstration 
activities. https://cordis.europa.eu/programme/id/FP7  
18 Horizon 2020 - EU Framework  Programme for  Research  and Innovation.    
https://ec.europa.eu/environment/integration/research/2020_en.htm  
19 https://www.timanalytics.eu/TimTechPublic/dashboard/index.jsp#/space/s_1713?ds=156446 
20 https://knowledge4policy.ec.europa.eu/biodiversity/topic/eu-research-project-policy-link-explorer_en 
21 Horizon Europe – Research  and innovation funding  programme until 2027.  
https://research-and-innovation.ec.europa.eu/funding/funding-opportunities/funding-programmes-and-open-calls/horizon-europe_en   
22https://ec.europa.eu/info/funding-tenders/opportunities/docs/2021-2027/horizon/wp-call/2023-2024/wp-1-general-introduction_horizon-

2023-2024_en.pdf 

23https://ec.europa.eu/info/funding-tenders/opportunities/docs/2021-2027/horizon/wp-call/2021-2022/wp-1-general-introduction_horizon-

2021-2022_en.pdf 

18 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                              
 
animal) towards safer, healthier, eco-efficient and competitive products and services for agriculture, fisheries, 
feed, food, health, forest-based and related industries.  

Specific Programme "Cooperation": Environment (including Climate Change) (FP7 -En viro nment) a imed at 
improving the sustainable management of environmental resources by advancing knowledge on interaction s 
between the climate, biosphere, ecosystems and human activities via multidisciplinary research. Environmen t 
and health, and natural hazards were covered as sub-topics under the area "Climate change,  po llution  an d 
risks." 

Specific Programme "Cooperation": Health (FP7-Health) aimed at improving the health of European c itiz ens,  
and strengthening the competitiveness and innovative capacity of European health-related  ind us tries and  
businesses. 

2.2.1.2  Horizon 2020 (2014-2020) programmes 

Pillar III (SOCIETAL CHALLENGES): "Health, demographic change and wellbeing " (H2020-E U.3.1) aimed at 
improving the lifelong health and wellbeing of all. Among its actions most relevant fo r biod ivers ity were 
"Preventing disease" (H2020-EU.3.1.2) and "Health care provision and integrated care" (H2020-EU.3.1.6) under 
topics such as "Innovative actions for improving urban health and wellbeing - addressing environment, climate 
and socioeconomic factors" (SC1-BHC-29-2020) and "Setting the priorities fo r a E u ropean en viro nmen t, 
climate and health research agenda" (SC1-HCO-13-2018).  

Pillar III (SOCIETAL CHALLENGES): "Food security, sustainable agriculture and forestry, marine, ma ritime and 
inland water research, and the bioeconomy" (H2020-EU.3.2) aimed to secure s u ffic ient s upplies  o f s afe, 
healthy  and high-quality food and other bio-based products by developing productive, sustainable and 
resource-efficient primary production systems, fostering related ecosystem s ervic es and  the rec o very of 
biological  diversity.  Among  its  actions  most relevant for biodiversity and health were "Sustainable and 
competitive agri-food sector for a safe and healthy diet" (H2020-EU.3.2.2), "Healthy and safe foods and diets  
for  all"  (H2020-EU.3.2.2.2),  "Sustainable  and  competitive  bio-based  industries  and  supporting  the 
development of a European bio-economy" (H2020-EU.3.2.4), "Sustainable agriculture and forestry"  (H2020-
EU.3.2.1), and "Increasing production efficiency and coping with climate change, while ensuring sustainab ility 
and resilience" (H2020-EU.3.2.1.1). 

Pillar III (SOCIETAL CHALLENGES): "Climate action, Environment, Resource E fficien cy an d Raw M aterials"  
(H2020-EU.3.5) aimed to achieve a resource- and water-efficient and climate change-resilient econo my an d 
society, protect and sustainably manage natural resources and ecosystems, and ensure a sustainable su pply 
and  use  of  raw  materials.  Among its actions relevant to biodiversity and health was "Protection of the 
environment, sustainable management of natural resources, water, biodiversity and  eco system s"  (H2020 -
EU.3.5.2). This action also co-funded the European partnership on biodiversity or BiodivERsA3, in clud ing 10 
research projects24 under the call on "Biodiversity and its influence on animal, human and plant health." 

(H2020-EU.1.1) also include several topics relevant to biodiversity and health. 

-Curie Actions (H2020-EU.1.3) and European Research Council 

2.2.1.3  Horizon Europe (2021-2027) ongoing calls/programmes 

Horizon Europe's Pillar II on Global Challenges and European Industrial Competitiveness covers  b oth h ealth 
and biodiversity as major topics under Cluster 1 and Cluster 6. 

Under Cluster 1, devoted to health, the HE Work programme (2021-22), and the HE Work programme (2023-
24) include the following destinations covering themes relevant for ecosystems and biodiversity: 

Destination 2 "Living and working in a health-promoting environment" c overs c alls  on  " Environ ment and  
health" and "Partnerships in health." These include the topics "European partnership for th e as ses smen t of 
risks from chemicals" (HORIZON-HLTH-2021-ENVHLTH-03-01), "Health impacts of climate change, costs an d 
benefits of action and inaction" (HORIZON-HLTH-2021-ENVHLTH-02-03) and "Methods for assessing h ealth-
related costs of environmental stressors" (HORIZON-HLTH-2022-ENVHLTH-04-01).  

Destination 3 "Tackling diseases and reducing disease burden" covers calls on "Tackling diseas es, " in clud ing 
the  topics  "Pandemic  preparedness"  (HORIZON-HLTH-2021-DISEASE-04-06  and  HORIZON-HLTH-2022-

24 Joint BiodivERsA call (2018-19) on "Biodiversity and its influence  on animal, human and plant health." 
https://www.biodiversa.eu/2019/10/07/2018-2019-joint-call/  

19 

 
 
                                              
 
DISEASE-07-02)  and  "A  roadmap  towards  the  creation  of  the  European  partnership  on  One  Health 
antimicrobial resistance (OH AMR)" (HORIZON-HLTH-2021-DISEASE-04-05). 

Under  Cluster  6  on  "Food,  Bioeconomy,  Natural  Resources,  Agriculture and Envi ronment," the HE Work 
programme (2021-22) and the HE Work programme (2023-24) include the following destin ations  c overing 
topics relevant to health and biodiversity: 

Destination  "Fair,  healthy  and  environmentally-friendly  food  systems  from  primary  production  to 
consumption" encompasses impact areas of the HE strategic plan (2021-24) on climate c h ang e mitigation 
and adaptation, enhancing ecosystems and biodiversity on land and water, sustainable foo d s ystems  from 
farm to fork on land and sea, good health and high-quality accessible healthcare, and clean and healthy air, 
water and soil. It covers topics relevant to food systems, health, biodiversity and agro -ec olog y un der c alls  
HORIZON-CL6-2021-FARM2FORK-01,  HORIZON-CL6-2022-FARM2FORK-01  and  HORIZON-CL6-2022-
FARM2FORK-02. 

Destination "Resilient, inclusive, healthy and green rural, coastal and urban communities" encompasses impact 
areas of the HE strategic plan (2021-24) on climate change mitigation and adaptation, enhancing ecosystems 
and biodiversity on land and water, sustainable food systems from farm to fork, and good health  and h igh -
quality accessible healthcare. Topics under this destination are covered u n der c alls  HORIZON -CL6-2021-
COMMUNITIES-01, HORIZON-CL6-2022-COMMUNITIES-01 and HORIZON-CL6-2022- COMMUNITIE S-02-two  
stage. 

Destination "Biodiversity and ecosystem services" is co-funding the European partnership on biodivers ity25 o r 
BiodivERsA+ under call HORIZON-CL6-2021-BIODIV-02. Its main objectives include several objectives relevant 
for health, and it emphasises the rollout of nature-based solutions. It is also funding call HORIZON-CL6-2023-
BIODIV-01-1 on impacts of chemical pollution on terrestrial biodiversity.  

Pillar I (Excellent Science) programmes, Marie Sklodowska-Curie Actions and Research Infras truc tures , also  
continue under HE. Both include topics relevant to biodiversity and health. 

2.2.2  CINEA support 

The European Climate Infrastructure and Environment Executive Agency (CINEA)26 runs programmes that fund 
projects relevant to biodiversity and health. These include the LIFE programme27 for environment and clima te 
action, programmes in the maritime sector, and others. 

The LIFE programme 

under the LIFE programme (2021-
biodiversity on a path to recovery by 2030 is one of its main goals. It consists of four sub-programmes , o ne 
of which is devoted to Nature and Biodiversity. The Nature and Biodiversity sub-prog ramm e, and  inclu des  
projects relevant for biodiversity and health. It will fund 39 projects with a total budg

health, which can be searched in the LIFE public database. 

25 BiodivERsA+: The European Biodiversity Partnership.  https://www.biodiversa.eu/  
26 CINEA – The European  Climate Infrastructure  and Environment Executive Agency.  https://cinea.ec.europa.eu/our-projects_en   
27 The LIFE Programme. https://cinea.ec.europa.eu/programmes/life_en  

20 

 
 
 
                                              
 
3  Conclusions 

Our main conclusion is that the connections between biodiversity and health are complex and manifold, a fact 
that calls for urgent attention in policymaking, and requires a multidisciplinary and multi-sectoral appro ach , 
involving  researchers and policymakers from the fields of human health, animal health, environmental 
science and social sciences. Scientific disciplines range from the evolutionary ecology of infectious  and n on -
infectious diseases to ethics, law and politics [2]. Biodiversity and health offers th e u niq ue o ppo rtunity to  
demonstrate how ecological, environmental, medical and social sciences can contribute to the improvement of 
human health and wellbeing through the conservation of biodiversity and the services it brings  to   so cieties. 
There  is  still  a  knowledge  gap  to  fill  between  the  ecology  of  health  and  the  concepts  supported  by 
international initiatives such as One Health or Planetary Health. Section 1 briefly summari s ed th e s tate o f 
research and touched on theoretical and methodological challenges, including the diversity o f pers pec tives 
and expertise to involve. 

The benefits of biodiversity for human health include the regulatory services provided b y ec osys tems th at 
improve the quality of the air, water and soil, the provisioning services that underpin most o f o ur fo od and  
medicines,  as  well  as  the  cultural  services  that  support  our  mental  health.  Interaction  with  biodiverse 
environments is integral to our health and wellbeing. Biodiversity also supports  h ealth  by c ontrib uting  to 
climate change mitigation and adaptation, and the recognition of climate c han ge as an  important factor 
influencing biodiversity as well as health brings new aspects in the current debate, encouraging collaboration  
and transdisciplinary working [3]. Biodiversity loss and the resulting disruption of ecos ystem s ervices  h ave 
far-ranging consequences for our health and wellbeing, directly as well as through other impac ts o f h u man 
activities. 

In sections 1 and 2.1.2.1 to 2.1.2.3 we have elaborated on the connections between biodiversity and  health 
and the domains of pollution, climate change and agriculture and on EU policies in th es e d omains . Hum an 
activities  that  cause  climate  change  and  pollution,  and  undermine the resilience of food systems and 
agriculture, also adversely affect biodiversity and health. The complex connections involved call for deepening 
our understanding of the direct and indirect pathways through more focused investigation. However, th ere is  
already a substantial body of evidence confirming that biodiversity loss h as  bo th ex ac erbated,  an d b een 
exacerbated by, pollution and climate change. Pollution and climate change, which are among th e five m ain 
direct drivers of biodiversity loss, also have a huge direct impact on human health. Agricultural intensification 
contributes to both pollution and climate change, as well as to other drivers of biodiversity loss. Of all human  
activities, unsustainable agriculture poses the highest threat to biodiversity. The resulting biodiversity lo ss  in 
turn weakens the ability of ecosystems to mitigate pollution impacts and climate change, to adapt to climate 
change, and to boost the resilience and sustainability of agriculture and food sys tems. Th e m ultiple s elf -
reinforcing feedback loops thus generated involve adverse and often unpredictable consequences for h uman 
health, and could get out of control if not addressed in a timely and coherent manner.  EU po licies  in th es e 
domains, which have been reinforced over the years and are at the core of the E uro pea n Green Deal, will 
impact  both  biodiversity  and  human  health  -  and  are  in turn impacted by the loss of biodiversity and 
ecosystem services. 

Biodiversity loss has many other important consequences for health. As described in sections 1 an d 2.1.2.4,  
recent research shows that biodiverse surroundings enhance human microbial diversity, th u s b oos ting o ur 
immunoregulatory functions and helping to prevent many non-communicable diseases. In a broader con text,  
interaction with nature and access to green spaces profoundly influence men tal and  ph ys ical h ealth and  
wellbeing, especially in children. As regards infectious diseases, the loss of natural habitat contributes  to th e 
spread of infectious zoonotic diseases. Last but certainly not the least, biodivers ity lies at  th e ro ot o f the 
medicines that keep us alive: both the development of modern pharmaceuticals and  the m ain tenan ce o f 
traditional systems of medicine depend on a wide range of plants, animals and m icroo rgan isms , withou t 
which they cannot be effective.  

Loreau et al. [8] reminded us that the idea that changes in biodiversity can impact how ecosystems fu nction  
has, over the last quarter century, gone from being a controversial notion to an accepted part of science and  
policy. As the field matures, it is high time to review progress and look ahead to the implementation o f th is  
knowledge.  Some  pathways  for  the  biodiversity  and  health  nexus  are  provided  in  [7,  188, 189] on the 
necessity of combining ecology and public health:  

21 

 
 
  Refoundation of traditional disciplines is recommended, with teaching in medicine and b io logy th at 
better considers the reality of infectious diseases as complex systems, necessitating integrative a n d 
transversal thinking and better collaboration between disciplines.  

  There is a need for change in governance methods that are now outdated. Gautier [188] argues th at 
the biodiversity/health nexus challenges the governance of the present biomed ical - and tec h nical 
expertise-
as the basis of a One Health Approach. Human health problems involving wild fauna and flora (Lyme 
disease, allergies, etc.) are provoking conflicts of expertise and evaluation methods between ecolog y 
professionals, human health professionals, and animal health professionals, and the health  field  is 
being shaken up by the irruption of new knowledge and new ways of thinking. 

-d

The multiple and complex interlinkages described above   and the associated risks for human health   call for 
coordinated intervention in all relevant policy domains: from pollution to climate c h ang e and d isaster ris k 
reduction to agriculture and food systems to medicine. With this synthesis we hope to draw atten tion to  all 
these factors and more, as well as to the EU policies and initiatives, including on res earc h and  inn ovation,  
which address them. Whilst health concerns are gaining increasing attention in EU policies on biodiversity and 
nature conservation, especially in the wake of Covid-19, it will be equally necessary to embed the importanc e 
of biodiversity in EU health policies. The multiple policy domains described in this repo rt n eed to  b e better 
integrated in a comprehensive, systemic One Health approach that prioritises win-win actions for health  and 
biodiversity. 

22 

 
 
 
 
 
 
 
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Arising from their Utilization to the Convention on Biological Diversity. https://www.cbd.int/abs/ 

[185] Directive 2004/24/EC of the European Parliament and of the Council of 31 March 2004 amending, as 
regards traditional herbal medicinal products, Directive 2001/83/EC on the Community code relating to 
medicinal products for human use. OJ L 136, 30.4.2004, p. 85 90. 
https://eur-lex.europa.eu/legal-content/en/ALL/?uri=CELEX%3A32004L0024  

[186] Committee on Herbal Medicinal Products (HMPC) of the European Medicines Agency (EMA). 
https://www.ema.europa.eu/en/committees/committee-herbal-medicinal-products-hmpc  

[187] HMPC work plan 2023 - adopted by the Committee on 25 January 2023, EMA/HMPC/855550/2022, 
Human Medicines Division, European Medicines Agency. 
https://www.ema.europa.eu/en/documents/work-programme/hmpc-work-plan-2023_en.pdf  

[188] Gautier, A., Gardon, S. and Déprés, C. (2023).  The emergence of the Biodiversity/Health nexus: making 
biodiversity a health issue  Review of Agricultural, Food and Environmental Studies, doi:10.1007/s41130-023-
00189-3, 104, 1, (27-46). 

[189] Morand, S. and Lajaunie, C. (2019) Linking Biodiversity with Health and Well-being: Consequences of 
Scientific Pluralism for Ethics, Values and Responsibilities. ABR 11, 153 168. https://doi.org/10.1007/s41649-
019-00076-4 

---------------------- 
Additional references 

Marselle, M. R., Martens, D., Dallimer, M. and Irvine, K. N. (2019). 

-being 
Biodiversity and Health in the Face of Climate Change (Cham: Springer), 175 211. 

doi: 10.1007/978-3-030-02318-8_9 

36 

 
 
 
 
 
 
 
 
 
 
 
  
 
 
 
 
Felappi, J. F., Sommer, J. H., Falkenberg, T., Terlau, W. and Kötter, T. (2020).  Green infrastructure through the 

-offs 

between mental health and wildlife support in cities . Sci. Total Environ. 748:141589. doi: 
10.1016/j.scitotenv.2020.141589 

Kosanic, A. and Petzold, J. (2020).  A systematic review of cultural ecosystem services and human wellbeing . 
Ecosyst. Serv. 45:101168. doi: 10.1016/j.ecoser.2020.101168 

Marselle, M. R., Martens, D., Dallimer, M., and Irvine, K. N. (2019).  Review of the mental health and well-being 
benefits of biodiversity , in Biodiversity and Health in the Face of Climate Change (Cham: Springer), 175 211. 
doi:10.1007/978-3-030-02318-8_9 

---------------------- 
References in footnotes  

Winefield, H. R., Gill, T. K., Taylor, A. W. and Pilkington, R. M. (2012).  Psychological well-being and psychological 
distress: is it necessary to measure both?  Psychol. Well-Being: Theory, Res. Pract. 2:3. doi: 10.1186/2211-
1522-2-3 

World Health Organization (2018).  Mental Health: Strengthening Our Response . Available online at:   
https://www.who.int/news-room/fact-sheets/detail/mental-health-strengthening-our-response 
(accessed August 2023) 

37 

 
 
 
 
 
 
 
 
List of abbreviations  and definitions   

Acquired ImmunoDeficiency Syndrome 
AntiMicrobial Resistance 
Active Pharmaceutical Ingredients 
European Union Common Agricultural Policy 
European Union Biodiversity Strategy for 2030 
Convention on Biological Diversity 
European Climate Infrastructure and Environment Executive Agency 
Coronavirus disease 2019 
European Union Environment Action Programme 
European Green Deal 
European Environment and Health Process 
European Medicines Agency 
European Parliament's Committee on Environment, Public Health and Food Safety 

AIDS 
AMR 
APIs 
CAP 
BDS 2030 
CBD 
CINEA 
COVID-19 
EAP 
EGD 
EHP 
EMA 
ENVI 
EU4Health  Programme for the European Union's action in the field of health  
F2F 
FP7 

Farm to Fork Strategy of the European Union 
Seventh framework programme of the European Community for research and technological 
development (2007-2013) 
Knowledge Centre for Biodiversity, established by the European Commission 
Horizon Europe, EU funding programme for research and innovation (2021-2027) 
Committee for Herbal Medicinal Products 
Knowledge for Policy, EU Commission's platform for evidence-based policymaking 
Sixth Global Environment Outlook from the United Nations Environment Programme 
Green Infrastructure 
European Union Member States 
New Approach Methodologies 
Non-Communicable Diseases 
Regulation on Registration, Evaluation, Authorisation and Restriction of Chemicals 
EU Directive on 'Restriction of Hazardous Substances' in electrical and electronic equipment 
Directorate-General for Research and Innovation  
Sustainable Use of Pesticides Directive 
Sustainable Use of Pesticides Regulation 
Food and Drug Administration of the United States 
Waste Electrical and Electronic Equipment 
European Union Water Framework Directive 
World Health Organization 
Zero Pollution Action Plan of the European Union 

KCBD 
HE 
HMPC 
K4P 
GEO-6 
GI 
MS 
NAMs 
NCDs 
REACH 
RoHS 
RTD 
SUD 
SUR 
USFDA 
WEEE 
WFD 
WHO 
ZPAP 

Biodiversity: the variability among all living organisms from all sources and the ecological 
complexes of which they are a part; this includes diversity within species, between species 
and of ecosystems (United Nations Convention on Biological Diversity, 2006). 

Health: a state of complete physical, mental and social well being and not merely the 
absence of disease or infirmity (WHO 1948) 

Mental health: a state of wellbeing in which an individual realizes their own abilities, can 
cope with the normal stresses of life, can work productively and is able to make a 
contribution to their community (World Health Organisation, 2018). 

Psychological wellbeing: a combination of positive affective states such as happiness (the 
hedonic perspective) and functioning with optimal effectiveness in individual and social life 
(the eudaimonic perspective) (Winefield et al., 2012). 

38 

 
 
 
 
 
 
 
List of figures   

Figure 1. Examples of issues that can be addressed 

Figure 2.  Biodiversity  and  health  infographic  as displayed by the EC Knowledge Centre for Biodiversity 
8 

. 

39 

 
 
 
 
 
 
 
 
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